Non-atherosclerotic coronary causes of myocardial infarction in women
- PMID: 39880182
- DOI: 10.1016/j.pcad.2025.01.008
Non-atherosclerotic coronary causes of myocardial infarction in women
Abstract
Ischemic heart disease is the most common cardiovascular cause of death in women worldwide. Obstructive coronary atherosclerosis is the primary cause of myocardial infarction (MI), however, non-atherosclerotic mechanisms of MI, such as spontaneous coronary artery dissection, vasospasm, microvascular dysfunction, embolization, inflammation, coronary anomalies, infectious and infiltrative causes are increasingly being recognized. Emerging data suggest that women are two to five times more likely to have an MI in the absence of coronary atherosclerosis compared to men, but they continue to remain underdiagnosed and undertreated, partly due to underdiagnosis and limited understanding of these mechanisms. Recent advancements in invasive and noninvasive imaging techniques and physiological testing allow for distinguishing these mechanisms from each other, providing a definitive diagnosis and tailored treatment. This review summarizes the existing literature on the non-atherosclerotic coronary causes of MI with a focus on evidence pertaining to women, offering a basis for future studies.
Keywords: Coronary arteritis; Coronary artery anomalies; Coronary emboli; Coronary vasospasm; Microvascular dysfunction; Myocardial infarction; Myocardial infarction with non-obstructive coronary arteries; Non-atherosclerotic causes; Spontaneous coronary artery dissection; Spontaneous coronary artery rupture.
Copyright © 2025. Published by Elsevier Inc.
Conflict of interest statement
Declaration of competing interest Nieves Gonzalo: Research grant: Abbott. Consultancy and speaker fees: Abbott, Boston Scientific, Abiomed, Shockwave, Philips. Kalyan R. Chitturi: Consultant: Glass Health. Natalia Pinilla-Echeverri: Consultant: Abbott Vascular, Conavi. Speaker and research grant: Abbott Vascular. Advisory Board: Abbott Vascular, Philips. Ron Waksman - Advisory Board: Abbott Vascular, Boston Scientific, Medtronic, Philips IGT, Pi-Cardia Ltd.; Consultant: Abbott Vascular, Biotronik, Boston Scientific, Cordis, Medtronic, Philips IGT, Pi-Cardia Ltd., Swiss Interventional Systems/SIS Medical AG, Transmural Systems Inc., Venous MedTech; Grant Support: AstraZeneca, Biotronik, Boston Scientific, Chiesi, Medtronic, Philips IGT; Speakers Bureau: AstraZeneca; Investor: MedAlliance, Transmural Systems Inc. Hector M. Garcia-Garcia: Consultant for Boston Scientific, Abbott, ACIST Medical, Biotronik, Terumo, and Medis; Institutional research grants from Medtronic, Boston Scientific, Abbott, Chiesi, Neovasc, Alucentbio, Biotronik, Corflow, Cordis, and Phillips. Payment or honoraria for speaking engagements, presentations, or support for attending meetings: Boston Scientific, Abbott, ACIST Medical, Biotronik, Terumo, and Medis. Patents issued: Application patent #17/434,497. Advisory board: VIVID study, Phillips sponsored study. All other authors: No relevant disclosures.
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